When should you submit a claim?
You might need to submit a claim when you:
- Visit an out-of-network provider
- Receive medical services in another country (use the international claim form) or while on a cruise ship (use the member claim form)
- You’re being reimbursed for vision or prescription products or services1
You might not need to submit a claim when you:
- Visit a North Carolina hospital for services or emergency care. If they have your insurance information, they'll file your claim for you.
- Use an in-network doctor. Need help finding an in-network provider? Try our Find Care tool.
Here's what to include with your claim
To avoid delays and have your claims processed accurately, be sure you submit all of the following:2
- A claim form - signed and completed for each member or patient who received care.
- A receipt - Your doctor will give you an itemized receipt for all the services you received. You should submit the original (not a copy) with your claim.
- Valid procedure codes - For example, 99203 is the code for an office or outpatient visit for evaluation. Get these codes from your doctor.
- Get a different procedure code for each service, and
- Get a separate charge for each procedure code
- A diagnosis code for services or supplies. Get these codes from your doctor.
Did you visit an out-of-state provider?
You should also provide this information from the referring provider and the provider you saw:
- Name and address
- NPI
- Tax ID number
Claim forms
Medical, vision and medical supplies claims forms
Prescription drug claims forms
Claim forms for services rendered outside of NC
Disclosures:
-
You can submit a claim for reimbursement of prescription products. Prescriptions filled within the last 7 days may be reimbursed at the pharmacy.
-
Please allow at least 7 days for us to receive your claim. You can check the status of your claim on Blue Connect.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
Information in other languages: Español 中文 Tiếng Việt 한국어 Français العَرَبِيَّة Hmoob ру́сский Tagalog ગુજરાતી ភាសាខ្មែរ Deutsch हिन्दी ລາວ 日本語
© 2023 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.